Obesity is Not Associated with an Increased Risk of Portal Vein Thrombosis in Cirrhotics
Gastroenterology and Hepatology from Bed to Bench,
Vol. 11 No. 2 (2018),
18 April 2018
,
Page 153-158
https://doi.org/10.22037/ghfbb.v0i0.1234
Abstract
Aim: To determine the impact of obesity on development of portal vein thrombosis in cirrhotic patients.
Background: Cirrhosis is a known risk factor for portal vein thrombosis (PVT). Evidence also points to obesity as being a risk factor
for venous thromboembolism. Limited information is available on how obesity impacts the development of PVT in cirrhotic patients.
Methods: This was a retrospective cohort study using the 2013 National Inpatient Sample. Patients older than 18 years with an ICD-9
CM code for any diagnosis of liver cirrhosis were included. There was no exclusion criteria. The primary outcome was the impact of
obesity on development of PVT. Obesity was also sub-classified according to body-mass index (BMI). Secondary outcomes were inhospital
mortality, ICU admission, shock, TPN use, and resource utilization. Odds ratios (OR) and means were adjusted for age, gender,
and ethnicity.
Results: We included 69,934 obese cirrhotics of which, 1,125 developed PVT (mean age 59 years, 35% female). Overall in-hospital
mortality rates were 9% (11% with PVT vs 5% without PVT). On multivariate analysis, obesity was not associated with a significantly
different adjusted OR for development of PVT compared to non-obese. When stratifying by obesity subtype, class 1 obesity was
associated with increased odds of PVT (OR: 1.45, 95%CI: 1.06-1.96, p=0.02), while class 3 obesity was associated with a decreased
odds of PVT (OR: 0.72, 95%CI: 0.58-0.88, p<0.01) compared to non-obese.
Conclusion: Obesity is not associated with increased odds of PVT.
Keywords: Obesity, Portal vein thrombosis, Cirrhosis, ICD-9.
(Please cite as: Zakko A, Kroner PT, Nankani R, Karagozian R. Obesity is not associated with an increased risk of
portal vein thrombosis in cirrhotic patients. Gastroenterol Hepatol Bed Bench 2018;11(2):153-158).
- Obesity
- Portal Vein Thrombosis
- Cirrhosis
- ICD-9
How to Cite
References
Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. New England Journal of Medicine 2017; 376: 254–266. DOI: 10.1056/NEJMra1514009.
World Health Organization Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. WHO Technical report series 894. 2000.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 746. DOI: 10.1016/S0140-6736(14)60460-8.
Musich S, MacLeod S, Bhattari G, Wang S, Hawkins K, Bottone F, et al. The Impact of Obesity on Health Care Utilization and Expenditures in a Medicare Supplement Population. Gerontology and Geriatric Medicine 2016; 2: 1-9. DOI: 10.1177/2333721415622004
Eckel, RH. Obesity and heart disease: a statement for healthcare professionals from the nutrition committee, American Heart Association. Circulation 1997; 96: 3248-3250. DOI: 10.1161/01.CIR.96.9.3248.
Yang G, De Staercke C, Hooper W. The effects of obesity on venous thromboembolism: a review. Open Journal of Preventive Medicine 2012; 2: 499-509. DOI: 10.4236/ojpm.2012.24069.
Allman-Farinelli MA. Obesity and venous thrombosis: a review. Seminars in Thrombosis & Hemostasis 2011; 37: 903-907. DOI: 10.1055/s-0031-1297369
Van Langevelde K, Flinterman LE, van Hylckama Vieg A, Rosendaal FR, Cannegieter SC. Broadening the factor V Leiden paradox: pulmonary embolism and deep-vein thrombosis as 2 sides of the spectrum. Blood 2012; 120: 933-946. DOI: 10.1182/blood-2012-02-407551.
Bureau C, Laurent J, Robic MA, Christol C, Guillaume M, Ruidavets J, et al. Central obesity is associated with non-cirrhotic portal vein thrombosis. Journal of Hepatology 2016; 64: 427–432. DOI: 10.1016/j.jhep.2015.08.024
Harding DJ, Perera MTP, Chen F, Olliff S, Tripathi D. Portal vein thrombosis in cirrhosis: Controversies and latest developments. World Journal of Gastroenterology: WJG 2015; 21: 6769–6784. DOI: doi.org/10.3748/wjg.v21.i22.6769
Yerdel MA, Gunson B, Mirza D. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation 2000; 69:1873-1881.
Ghabril M, Agarwal S, Lacerda M, Chalasani N, Kwo P, Tector AJ. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: Analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation 2016; 100:126-133. DOI: 10.1097/TP.0000000000000785
Ayala R, Grande S, Bustelos R, Ribera C, Garcia-Sesma A, Jimenez C, et al. Obesity is an independent risk factor for pre-transplant portal vein thrombosis in liver recipients. BMC Gastroenterology 2012; 12: 114. DOI: 10.1186/1471-230x-12-114
Tripodi A, Anstee QM, Sogaard KK, Primignani M, Valla DC. Hypercoagulability in cirrhosis: causes and consequences. J Thromb Haemost 2011; 9: 1713–1723. DOI: 10.1111/j.1538-7836.2011.04429.x.
Okuda K, Ohnishi K, Kimura K, Matsutani S, Sumida M, Goto N, et al. Incidence of portal vein thrombosis in liver cirrhosis: an angiographic study in 708 patients. Gastroenterology 1985; 89: 279–286. https://doi.org/10.1016/0016-5085(85)90327-0.
Yamashita Y, Bekki Y, Imai D, Ikegami T, Yoshizumi T, Ikeda T, et al. Efficacy of postoperative anticoagulation therapy with enoxaparin for portal vein thrombosis after hepatic resection in patients with liver cancer. Thromb Res 2014; 134: 826–831. DOI: 10.1016/j.thromres.2014.07.038.
Francoz C, Belghiti J, Vilgrain V, Sommacale D, Paradis V, Condat B, et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut 2005; 54: 691–697. DOI: 10.1136/gut.2004.042796.
Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, Ponziani F, et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 2009; 51: 682–689. DOI: 10.1016/j.jhep.2009.03.013.
Tripodi A, Primignani M, Chantarangkul V, Dell’Era A, Clerici M, de Franchis R, et al. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology 2009; 137: 2105–2111. DOI: 10.1053/j.gastro.2009.08.045.
Molina AR, Vilchez AR, Dominguez MB, Garcia AN, San Miguel CM, Gonzalez AR, et al. Influence of Body Mass Index on Venous Thrombotic Complications of Liver Transplants. Transplantation Proceedings 2016; 48: 3017-3020. DOI: 10.1016/j.transproceed.2016.10.001.
Stein P, Beemath A, Olson R. Obesity as a risk factor in venous thromboembolism. The American Journal of Medicine 2005; 118: 978-980. DOI:10.1016/j.amjmed.2005.03.012.
Samad F, Ruf W. Inflammation, obesity, and thrombosis. Blood 2013; 122: 3415-3422. DOI: 10.1182/blood-2013-05-427708.
Santilli F, Vazzana N, Liani R, Guagnano MT, Davi G. Platelet activation in obesity and the metabolic syndrome. Obs Rev 2012; 13: 27-42. DOI: 10.1111/j.1467-789X.2011.00930.x.
Shafer K, Konstantinides S. Mechanisms linking leptin to arterial and venous thrombosis: potential pharmacological targets. Current Pharmaceutical Design 2014; 20: 635-640. DOI: 10.2174/13816128113199990021.
Amundson D, Djurkovic S, Matwiyoff G. The Obesity Paradox. Critical Care Clinics 2010; 26: 583-596. DOI: http://dx.doi.org/10.1016/j.ccc.2010.06.004.
Karagozian R, Bhardwaj G, Wakefield D, Baffy G. Obesity paradox in advanced liver disease: obesity is associated with lower mortality in hospitalized patients with cirrhosis. Liver international 2016; 36: 1450-1456. DOI: 10.1111/liv.13137.
Uppot R, Sahani D, Hahn P, Gervais D, Mueller P. Impact of Obesity on Medical and Image-Guided Intervention. American Journal of Roentgenology 2007; 188: 433-440. DOI: 0.2214/AJR.06.0409.
- Abstract Viewed: 232 times
- PDF Downloaded: 150 times